Giant congenital nevus

  • Definition
    • A congenital pigmented or melanocytic nevus is a dark-colored, often hairy, patch of skin. A congenital nevus is present at birth or appears in the first year of life. 

      A giant congenital nevus is smaller in infants and children, but it usually continues to grow as the child grows. A giant pigmented nevus is larger than 8 inches (20 centimeters) once it stops growing.

  • Alternative Names
    • Congenital giant pigmented nevus; Giant hairy nevus; Giant pigmented nevus; Bathing trunk nevus; Congenital melanocytic nevus - large

  • Causes
    • These marks are thought to be caused by problems that develop as a baby grows in the womb. In some families bathing trunk nevi may be inherited.

      The condition may occur with:

      • Growth of fatty tissue cells
      • Neurofibromatosis (an inherited disease involving changes in skin pigment and other symptoms)
      • Other nevi
      • Spina bifida (a birth defect in the spine)

      Smaller congenital pigmented or melanocytic nevi are common in children and do not cause problems most of the time. Larger or giant nevi are rare.

  • Symptoms
    • A nevus will appear as a dark-colored patch with any of the following:

      • Brown to bluish-black color
      • Hair
      • Regular or uneven borders
      • Smaller affected areas near the larger nevus (maybe)
      • Smooth, irregular, or wart-like skin surface

      Nevi are commonly found on the upper or lower parts of the back or the abdomen. They may also be found on the:

      • Arms
      • Legs
      • Mouth
      • Mucus membranes
      • Palms or soles
  • Exams and Tests
    • You should have all birthmarks looked at by a health care provider. A skin biopsy may be needed to check for cancer cells.

      An MRI of the brain might be done if the nevus is over the spine. A giant nevus on the spine may be linked to brain problems.

      Your doctor will measure the dark skin area every year and may take pictures to check if the spot is getting larger.

  • Treatment
    • You will need to have regular exams to check for skin cancers.

      Surgery to remove the nevus can be done for cosmetic reasons or if your provider thinks it may become skin cancer. Skin grafting is also done when needed. Larger nevi may need to be removed in several stages.

      Lasers and dermabrasion (rubbing them off) can also be used to improve appearance. These treatments may not remove the whole birthmark, so it may be harder to detect skin cancer (melanoma). Talk to your doctor about the pros and cons of surgery for you.

      Treatment may be helpful if the birthmark causes emotional problems because of how it looks. 

  • Outlook (Prognosis)
    • Skin cancer may develop in some people with large or giant nevi. The cancer risk is higher for nevi located on the back or abdomen. 

  • Possible Complications
    • Having a giant nevus may lead to:

      • Depression and other emotional problems if the nevi affect appearance
      • Skin cancer (melanoma)
  • When to Contact a Medical Professional
    • This condition is usually diagnosed at birth. Talk to your child's health care provider if your child has a large pigmented area anywhere on their skin.

  • References
    • Habif TP. Nevi and malignant melanoma. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 22.

      James WD, Berger TG, Elston DM. Melanocytic nevi and neoplasms. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 30.